Microbiological and Chemical Quality of Packaged Sachet Water and Household Stored Drinking Water in Freetown, Sierra Leone

<div><p>Packaged drinking water (PW) sold in bottles and plastic bags/sachets is widely consumed in low- and middle-income countries (LMICs), and many urban users in sub-Saharan Africa (SSA) rely on packaged sachet water (PSW) as their primary source of water for consumption. However, few rigorous studies have investigated PSW quality in SSA, and none have compared PSW to stored household water for consumption (HWC). A clearer understanding of PSW quality in the context of alternative sources is needed to inform policy and regulation. As elsewhere in SSA, PSW is widely consumed in Sierra Leone, but government oversight is nearly nonexistent. This study examined the microbiological and chemical quality of a representative sample of PSW products in Freetown, Sierra Leone at packaged water manufacturing facilities (PWMFs) and at points of sale (POSs). Samples of HWC were also analyzed for comparison. The study did not find evidence of serious chemical contamination among the parameters studied. However, 19% of 45 PSW products sampled at the PWMF contained detectable <i>Escherichia coli</i> (EC), although only two samples exceeded 10 CFU/100 mL. Concentrations of total coliforms (TC) in PSW (but not EC) increased along the supply chain. Samples of HWC from 60 households in Freetown were significantly more likely to contain EC and TC than PSW at the point of production (p<0.01), and had significantly higher concentrations of both bacterial indicators (p<0.01). These results highlight the need for additional PSW regulation and surveillance, while demonstrating the need to prioritize the safety of HWC. At present, PSW may be the least unsafe option for many households.</p></div

Log bacterial concentrations in samples.

<p>Log of A) <i>E</i>. <i>coli</i> and B) Total coliform concentrations (CFU/100 mL) measured in raw water and finished packaged sachet water (PSW) samples at the packaged water manufacturing facility (“Raw” and “PWMF”, respectively) and in PSW samples as well as on the exterior of PSW samples at the point of sale (“POS” and “Exterior”, respectively) and in household water for consumption (“HWC”). Boxes represent average log concentrations, whiskers represent 95% confidence intervals for log concentrations.</p

P-values for Wilcoxon-Mann-Whitney tests (unpaired data) and Wilcoxon signed-ranks tests (paired data) comparing log concentrations of fecal indicator bacteria (FIB) in samples (first row) and hypothesis tests comparing proportions of positive samples (second row) (McNemar’s chi square test for paired data, and Fisher’s exact for unpaired data) for samples collected at different points in the supply chain.

<p>*indicates statistically significant difference at 95%.</p><p>**indicates statistically significant difference at 99%.</p><p>P-values for Wilcoxon-Mann-Whitney tests (unpaired data) and Wilcoxon signed-ranks tests (paired data) comparing log concentrations of fecal indicator bacteria (FIB) in samples (first row) and hypothesis tests comparing proportions of positive samples (second row) (McNemar’s chi square test for paired data, and Fisher’s exact for unpaired data) for samples collected at different points in the supply chain.</p

Bacterial concentrations in samples by risk category.

<p>Concentrations of A) <i>E</i>. <i>coli</i> and B) Total coliforms (CFU/100 mL) measured in raw water and finished packaged sachet water (PSW) samples at the packaged water manufacturing facility (“Raw” and “PWMF”, respectively) and in PSW samples as well as on the exterior of PSW samples at the point of sale (“POS” and “Exterior”, respectively) and in household water for consumption (“HWC”).</p

Microbial results for raw, finished packaged sachet water (PSW) samples, and household stored water samples.

<p>Microbial results for raw, finished packaged sachet water (PSW) samples, and household stored water samples.</p

Results of chemical analysis for raw water and finished packaged sachet water (PSW) samples.

<p>^a ND—not detect.</p><p>Mean (range), % compliant with WHO guidelines, (n).</p

All SPSS Tables and Outputs from Assessments of Ebola knowledge, attitudes and practices in Forécariah, Guinea and Kambia, Sierra Leone, July–August 2015

The border region of Forécariah (Guinea) and Kambia (Sierra Leone) was of immense interest to the West Africa Ebola response. Cross-sectional household surveys with multi-stage cluster sampling procedure were used to collect random samples from Kambia (<i>n</i> = 635) in July 2015 and Forécariah (<i>n</i> = 502) in August 2015 to assess public knowledge, attitudes and practices related to Ebola. Knowledge of the disease was high in both places, and handwashing with soap and water was the most widespread prevention practice. Acceptance of safe alternatives to traditional burials was significantly lower in Forécariah compared with Kambia. In both locations, there was a minority who held discriminatory attitudes towards survivors. Radio was the predominant source of information in both locations, but those from Kambia were more likely to have received Ebola information from community sources (mosques/churches, community meetings or health workers) compared with those in Forécariah. These findings contextualize the utility of Ebola health messaging during the epidemic and suggest the importance of continued partnership with community leaders, including religious leaders, as a prominent part of future public health protection.This article is part of the themed issue ‘The 2013–2016 West African Ebola epidemic: data, decision-making and disease control’